To make new preventive services benefits requirements work properly, federal agencies may need to help update coding and billing practices, according to America’s Health Insurance Plans (AHIP.
Carmella Bocchino, an executive vice president at AHIP, Washington, has included that suggestion in a comment on preventive services interim final regulations issued by arms of the U.S. Treasury Department, the U.S. Labor Department and the U.S. Department of Health and Human Services (HHS).
The departments issued the regulations in July to implement sections of the Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA).
The Employee Benefits Security Administration (EBSA), part of the Labor Department, has posted public comments on the preventive services regulations on its website. The regulations implement laws that will require non-grandfathered insurance policies and health plans to cover a specified package of preventive services without imposing deductibles or other cost-sharing requirements.
EBSA also has posted public comments on processes for reviewing internal and external appeals of health plan decisions.
EBSA has posted 88 review process comments and 261 preventive services comments.
Many of the individuals who posted comments have asked that federal agencies think about the interests of the patients, providers or other parties that the individuals represent.
The American Academy of Pediatrics, Washington, joined with several other children’s health groups to ask that the agencies include pediatricians and maternity care experts be included in internal and external review processes.
“Children are not little adults, and the appropriate standard of care for pediatric medicine is often quite different than for adult medicine,” Robert Hall writes on behalf of the American Academy of Pediatrics and allied groups. “What may appear to be inappropriate for adults can be medically necessary for children. In addition, the care of pregnant women is also important and very different than care for other populations.”
Many individuals wrote on behalf of chiropractic groups to ask that regulators give carriers more specific guidance regarding appropriate